HomeMy WebLinkAboutPass - Title V Inspection Report - 315 ABBOTT STREET 7/1/2024 Commonwealth of Massachusetts
.wa Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
315 AB OTT STREET
Property Address
MARGORIE ROTHSCHILD
Owner Owner's Narne
ouir
page MA abon 6,s NORTH ANDQVER 01845 JUNE 1 , 2024
required for every .... __.. _ _ .....
CiiWfowrn Mate fop Code crate of Inspection
Inspection results must be submitted can this form. Inspection forms may not be altered in any
way. please see completeness checklist at the end of the farm, 9 ,
tmpoctarrt;vtthen A. Inspector Information
filling out forms `a
on the computer„use only the tab Todd James Batesorl t, ,�"'
_ ..
key to move your Name of Inspector
cursor-do not ...
Bateson Enterprises Inc. _... ......... _.._._. . _._._... _ _
use the return Company Name __. _ � ��v.r
key. a ��
111 Arcllla Road
...__..._._..__.
Company Address
Andover IAA ,A ° " 01810
._. ....... _ ...._.. . ...__ _..__._ -
_.... _ _, v...._...._.......___ ._.._. .. . ....
�--- CltyCfiowwn .,State Zlp Code
978-475-4786 I-16
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5
(310 CIMIR 16.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection, and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1, Passes
Z Conditionally Passes
3, Needs Further Evaluation by the Local Approving Authority
4, E3 Fails
_.._. J LI N E w20, 2024
Inspecto signature Gate
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10„000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of Inspection and under the
conditions of use at that time.This Inspection does not address how the system will perform
in the future under the same or different conditions of use.
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ommonwealth of Massachusetts
it Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
315 ABBOTT STREET
Property Address
MARGORIE ROTHSCHILD
Owner Owners Name . .._ ....._.... .. _. _ ... ...... .
nforrriat6on is
requ�red for every NORTH ANDOVER MA 01€4.5 JUNE 13,_2024
page. City/Town State Zip Code Date of kispection
_.................---_... .....................__w__..,...., ... .. . __.._ _.....__... ....._.. _..._.._._. _ _..._.
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
Z I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaWated are
indicated below.
Comments:
) System Conditionally Passes:
Cl one or more systern components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair„ as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
"f he septic tank is metal and over 20 years old* or the septic tank (whether rnetal or not) is structurally
unsound, exhibits substantial 'infiltration or exfiltration or tank failure is imminent. System will pass
Inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound,: not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available,
El Y ❑ N Ej ND (Explain below);
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Commonwealth of Massachusetts
� d Title 5 Official Inspection Form
�m
�w
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
' 315 ABBOTT STREET
Property Address
MAR ORIE ROTHSCHILD
Owner
Owner's Name
inforrfor every is
re NORTH ANDOVER MA 01845 JUNE 18„ 2024
� reded f�r
4
page. Catyffow-n State dap Cade Clete of Inspection
C. Inspection Summary (cant.)
2) System Conditionally Passes (cant.):
�_. Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
El Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box, System will
pass inspection if(with approval of Board of Health):
broken pipe(s) are replaced D Y ❑ N El ND (Explain below):
El obstruction is removed ail Y ❑ N 0 NIA (Explain below):
�. distribution box is leveled or replaced [-1 Y ❑ N E ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
..w broken pipe(s) are replaced Y ❑ N ND (Explain below):
El obstruction is removed . Y ❑ N ( NO (Explain below):.
3) Further Evaluation is Required by the Board of Health:
El Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health„ safety or the environment
a. System will pass unless Board of Health determines in accordance with 310 CMR
1 .303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
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m
Commonwealth of Massachusetts
4 � Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
315 ABBOTT STREET
Oroperty Ad6ress
MARGORIE ROTHSCHILD
C)wrner ........ _ __
Owner's Name
required for
us NORTH ANDOVER MA 01845 JUNE 18, 2024
rer�a�ired for every ----
page Cnty/Town Stag Zip Code Cate of Inspection
C. Inspection Summary (coat.)
[l Cesspool or privy is within 50 feet of a surface water
m Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will flail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning In a manner that protects the public health,
safety and environment:
The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
[.] The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
. The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
0 The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well*.
Method used to determine distance:
* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm„ provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form,
c. tither:
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or
� � clogged SAS or cesspool
Cl z Discharge or pending of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
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Commonwealth of Massachusetts
x Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 ABBOTT STREET-T
,......., ---- _.
Property Address
MARGORIE ROTHSCHILD
`owner Owner's
Name
requiredofre NORTH ANDOVER MA 01345 ,TUNE 13, 2024
required for every
page Cstyaown State Zip Code Cate Iof Inspection
C. Inspection Summary (cant.)
4) System Failure Criteria Applicable to All Systems: (coat.)
Yes No
z Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
l z Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/day flaw
0 z Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped: ,® .
.l Z Any portion of the SAS, cesspool or privy is below high ground water elevation.
El z Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supplyFj .
z Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
El Z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Ej z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. (This
system passes if the well water analysis, performed at a Dl P certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this forma
El Z The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,,000 gpd.
11 z The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or "no"to each of the following, in addition to the
questions in Section CA
Yes No
El 0 the system is within 400 feet of a surface drinking water supply
E] 0 the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area r-IWPA) or a mapped Zone II of a public water supply well
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Commonwealth of Massachusetts
y Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
t4 �"
315 ABBOTT STREET
Property Address
MARGORIE ROTHSCHILD
Owner Owner's Name
mforregUiredfor ue NORTH ANDOVER MA 01845 JJUNE 18, 2t�24
required for every _ ..... . .,.--
page. state Lip Code Date of Inspection
_._.._,__. _.........._......___...w_..__ . w... .... _n__. ._ _._..............,.,...
C. Inspection Summary (cant.)
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered `.`yes`°to any question in Section CA above the large sy tern has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
5. You must indicate "yes" or"no" for each of the fallowing for all inspections:
Yes No
Z 1:1 Pumping information was provided by the owner, occupant„ or Board of Health
Z Were any of the system components pumped out in the previous two weeks?
Z C] Has the system received normal flows in the previous two week period?
0 Z Have large volumes of water been introduced to the system recently or as part of
this inspection?
,,,, 0 Were as built plans of the system obtained and examined? (If they were not
available note as H/A)
El Was the facility or dwelling inspected for signs of sewage back up?
El 1:1 Was the site inspected for signs of break out?
Z 1:1 Were all system components, excluding the SAS„ located on site?
4 Were the septic tank manholes uncovered, opened„ and the interior of the tank
Inspected for the condition of the baffles or tees„ material of construction„
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systerns?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
Z El Existing information. For example, a plan at the Board of Health.
Z El Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
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Commonwealth of Massachusetts
WIf Ti#I e 5 tffiil Inspection Form
rr
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
"° .. 315 ABBOTT STREET
�w
F�roperty Address
MARGORIE ROTHSCHILD
Owner Owner's Nwne
mformation is
required for every NORTH ANDOVER _ MA 01845 JUNE 18,.2024
page CftyfTown state Zip Code Date of Inspection
w ..._. .m.._.__ _,._..... ....w w... ..._._...._..... ...................... _..... ... ..... .........._,......__...... _......_ _..._
D. System Information
1, Residential Flow Conditions:
Number of bedrooms (design): ".. Number of bedrooms (actual): ___
DESIGN flow based on 310 CMR 15.203 (for example: 110 god x## of bedrooms): -NA
Description:
Number of current residents:
2
Does residence have a garbage grinder? Z Yes 0 No
Does residence have a water treatment unit? [-1 Yes Z No
If yes, discharges to: .....
Is laundry on a separate sewage system? (Include laundry system inspection 7 Yes Z No
information in this report.)
Laundry system inspected? Z Yes No
Seasonal use? D Yes Z No
Water meter readings, If available last 2 ears usage d SEE ATTACHED
g ( y g (gp })�
Detail:
Sumo Pump? 0 Yes Z No
Last date of occupancy: CURRENT
Date
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface sewage Disposal System Form Not for Voluntary Assessments
15 ABBOTT STREET
Property Address
MAR ORIE ROTHSCHILD _.
Oww,ier Owner's Name
information is required for every NORTH ANDOVER MA 01845 JUNE 18, 2024
_. ..... ...... .. . .. -
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203). Gailons per day(9pd)
Basis of design flow(seats/persons/sq.ft., etc.);
Grease trap present? ❑ Yes No
Water treatment unit present? ❑ Yes E] No
if yes, discharges to:
Industrial waste holding tank present? ❑ Yes E] No
Non-sanitary waste discharged to the Title 5 system? FI Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use Date
Other(describe below):
__
3. Pumping Records:
Source of information: JANUARY 2023 OWNER
Was systern pumped as part of the inspection? El Yes Z No
If yes, volume pumped: galloffs _
How was quantity pumped determined?
Reason for pumping:
tainsp doc•rev.7(2612016 1 ffle b d:Mr`,aE[nspaaOjori reborn Subsurface Sewage Dtsprosai Sys tern,Page 6 of W
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
315 ABBOTT STREET
Property A66ress
MARGC R'IE ROTHSCHILD
Owner Owner's Larne
information isNORTH ANDOVER MA 01345 JUNE 13„ 2024
required for every
page, CityM)wan State Zip Code Date of Inspection
_.- _ ,_..._.. ... _...__,_...._.a__....._ ... . . .... _.._. ..._ _,. m. ....._ ._,..........,,.a._..,.......
D. System Information (cont.)
4. Type of System:
z Septic tank, distribution box, soil absorption system
[ Single cesspool
(� Overflow cesspool
Cal Privy
Shared system Byes or no) (if yes„ attach previous inspection records„ if any)
I . Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by systern operator under contract
( � Tight tank. Attach a copy of the DEP approval.
0 Other(describe).
Approximate age of all components, date installed (if known) and source of information:
11 YEARS, INSTALLED OCTOBER 2013, AS GUILT PLAN
Were sewage odors detected when arriving at the site? (w_] Yes Z No
5, Building Sewer(locate on site plan):
Depth below grade: 1 "
feet
Material of construction:
cast iron Z 40 PVC other (explain):
Distance from private water supply well or suction line:
feet
Comments (on condition of joints„ venting, evidence of leakage, etc.)
JOINTS AND VENTING OK
NO EVIDENCE OF LEAKAGE
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Commonwealth of Massachusetts
, ,z, Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm Not for Voluntary Assessments
315 ABBOTT STREET
Property Address
MARGORIE ROTHSCHILD
Owner awrber's Nartieinfor
required
us NORTH ANDOVER MA 01845 JUNE 18, 2024
required for every .. _ .. _._... _.
page. City/Town State Zip Code Coate of Inspection
_....._.. __. w. _ ._,w.._ _ -_.-_ _.....
D. System Information (cant.)
6. Septic Tank (locate on site plan):
Depth below racier 3'.'_ IN PAVEMENT
p g feet
Material of construction:
concrete D metal [ fiberglass ( ] polyethylene other (explain)
If tank is metal„ list aye: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes P No
Dimensions: 10' X 5' X 4'
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle 2
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee or baffle NA
How were dimensions determined? SLUDGE JUDGE AND TAPE
MEASURE
Cornments (on pumping recornmendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
RECOMMEND PUMPING OLDER SYSTEMS YEARLY AND CLEAN FILTER
PLASTIC INLET AND OUTLET TEES OK
TANK IN GOOD CONDITION
NO EVIDENCE OF LEAKAGE
NORMAL LIQUID LEVELS
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Commonwealth of Massachusetts
' Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not far Voluntary Assessments
° � � Y y
� 4
315 ABBOTT STREET
Property A6dress
MARGORIE ROTHSCHILD
Owner
Owner's Marne
information is required for every NORTH ANDOVER MA 1845 JUKE 18„ 2024
_ _
page City/Town State Zap Cade Crate of Inspection
D. System Information (coot.)
7. Grease Trap (locate on site plan):
Depth below grade: fed
Material of construction:
0 concrete El metal E fiberglass ❑ polyethylene other(explain):.
Dirensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottorn of scum to bottom of outlet tee or baffle ---------
Date of last pumping; gate
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete El metal E] fiberglass F-1 polyethylene other(explain):
Dimensions:
Capacity:
gallons
Design Row:
gakons per day
t5insp.doc-rev 712t3 2018 'Tale s Off'cwl Inspeeorm rom:Subsurface Sewage Ulspusal Syslerl,Papa's 1 of 18
Q Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
315 ABBOTT STREET
Property Address ..
MARGORIE ROTHSCHILD
Owner _
Owner's Nance
information is required for every NORTH ANDOVER MA 01845 JUNE 18, 2024
page City/Town State Zip Cade Cate of Inspection
. . ........,_.. ......... _...._. .,w._._..._ .w. ... ._..w....., _.._ _.._ _.._ .................._.__v__w_.
D. System Information (cont.)
8. Tight or Holding Tank (cant.)
Alarm present; D Yes El No
Alarm level; Alarm in working order: El Yes 0 No
Date of last pumping:
r.7a te
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? �] Yes Na
9. Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 1 2" _
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc,):
D--BOX LEVEL AND DISTRIBUTION IS EQUAL
LIGHT SOLIDS CARRYOVER
NO EVIDENCE OF LEAKAGE
D-BOX HAS SPEED LEVELERS
_........
t5insga,doc.xev.7/2612016 '1 tlea 5 Offi.iaV Inspecton Form Subsuirace Sewage aosFcrs al System-Page 12 of 18
' Commonwealth of Massachusetts
, Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
sra;y
315 ABB TT STREET
Property Address
MARGORIE ROTi HSCHILD
Owner Owner's Name
required
is NORTH ANDOVER MA 01845 JUKE 18, 2024
rerp�ahred for every _. -----
page. Crty/Town State _ Zip Cade Date of Inspection
D. System Information (coat.)
10, Pump Chamber(locate on site plan);.
Pumps In working order: El Yes 7 No*
Alarms in working order: E
.1 Yes ado*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc,):
If purnps or alarms are not in working order, system is a conditional pass.
11. Soil ,Absorption System (SAS) (locate on site plan, excavation not required'):
If SAS not located, explain why:
Type:
7 leaching pits number:
E_] leaching chambers number:
.w.
leaching galleries number:
leaching trenches number, length:
leaching fields number, dimensions:
1; 20' X37'
[u] overflow cesspool number:
El innovative/alternative system
Type/name of technology:
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Commonwealth of Massachusetts
1 Title . Official Inspection Form
i' Subsurface Sewage Disposal System Farm - Not for Voluntary Assessments
15 ABBOTT STREET
Property Address _. .
MARGORIE ROTHSCHILD
Owner Owner's!Name _
information is required for every NORTH ANDOVER MA 1 01345 »)LINE 1$„ 2124
_
page 6tyfTown_ . Mate Zip Corte Crate of inspection
_.__-._
D. System Information (cent.)
11, Sail Absorption System (SAS) (cant.)
Comments (note condition of soil„ signs of hydraulic failure, level of ponding„ darnp soil, condition of
vegetation, etc.):
SOIL AND VEGETATION O
NO EVIDENCE OF HYDRAULIC FAILURE OR PONDING
........ .
12, Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow 0 Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5"ensp.cluac,-rev.7l'2W20184 'r'dlo 5 Oftirda f Inspection For11 tiubsud ace Sewage Disposal System-Page 14 of 16
Commonwealth of Massachusetts
- �� TUE 5 Official Inspection Form
_.µ �1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
318 ABBOTT STREET
Property Address
MARGORIE ROTHSCHILD
Owner
Owner's Name
information Is NORTH ANDOVER MA 01845 DUNE 18, 2924
repaired for every ----
page CityfTown State Zip Code Date of Inspection
_..,... „_.._w.... _....,... _....__ _._ ... _. .......
D. System Information (cant.)
13, Privy (locate on site plan),-
Materials of construction;
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t`a"ns{„doc-i ev.7126F2018 '1'1Tio 5 OftlioW Inspection e'rymn Subsuriaw Sewage Disposal System.Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
315 ABBOTT STREET
: ------- - ........ .- -------------Property�aa '
MARGORIE ROTHSCHILD
Owner __ ......._..
s ...............
Owner"
niformation is requked for every NORTH ANDOVER MA 01845 JUNE 18, 2024
page, City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14, Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet, Locate where public water supply enters
the building. Check one of the boxes below:
hand-sketch in the area below
drawing attached separately
mr
2.
ct
j
�500 Galloll
tNnsp dot-rev 78 6/2018 TWa 5 Offidai hspection Form Subsurface Sewage Maposal SyMam-Flage 16 of 18
Commonwealth of Massachusetts
l I T t"le 5 Official Inspection Form
W Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c ��a
<M7 15 ABBOTT STREET
............
_..,. Property Address
MARGORIE ROTHSCHILD
Owner bwn is Name _
information ds NORTH ANDOVER MA 01845 JUNE 18, 2024
required for every �.
page. City/Town State Zip Code Date of Inspection
_....___.._ ............... .....................
_.._._ .._..._ _.a_.._.... ........_ __. ._ ........._.__...
D. System Information (cant.)
15. Site Exam
E Check Slope
Z Surface water
Check cellar
Shallow wells
Estimated depth to high ground water. . .._
feet
Please indicate all methods used to determine the high ground water elevation:
z Obtained from system design plans on record
If checked, date of design plan reviewed: JULY 1997
rate
_ Observed site (abutting property/observation hole within 150 feet of SAS)
z Checked with local Board of Health -explain:
AS BUILT ON FILE ONLY, TOWN UNABLE TO LOCATE DESIGN PLAN
E] Checked with local excavators, installers - (attach documentation)
z Accessed USGS database -explain:
ESSEX COUNTY SOIL. MAP
You must describe how you established the high ground water elevation
CANTON FINE
DEPTH TO WATER TABLE > 80"
BUILT A MINIMUM OF 3" ABOVE WATER TABLE
SYSTEM ABOVE WATER TABLE
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
tfxnsap.doc•rev."712612018 'p'iHe 5 ofd"oC4 Ospecthoo Form Sr.rbmPrface Sewage Disposal System.Page'1"7 of 18
Commonwealth of Massachusetts
Title 5 Wficiel Inspection Form
F, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^;z 315 ABBOTT STREETF poperty Gi res
MARGORIE ROTHSCHILD
Owner Owner's Name
information as NORTH ANDOVER MA 01845 JUKE 16, 2624
required for every ..
Page C ityfTown Mete Zip Code Date of Inspection
........_,.._.,_.,... __.. ,_........._._ ,.„.a._......., .......__....._.__.._.............._...........,_.. .__...,............_...._._._......... _._.________.,._......_ ......... __.. _.._...__. _,,..__ .__.,_.._.._._...._...
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of.
A. Inspector Information: Complete all fields in this section..
X B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
EXI C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
D. System Information:
For 6: Tight/Holding Tank-- Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15, Explanation of estimated depth to high groundwater included
15,nsp.a9oc•rev,71260.)i 6 1"ipW 5 Official lnsp eoion Form Subsurface Sewage Disposal SyMem-Page 18 of 18
Su"wnwy Rewd Card genwaled on 6117�2024 2,14 12 PM by Kam Hanlon Page 1
Town of North Andover
Tax Map # 210-038.0-0337-0000.0
Parcel Id 28384
315 ABBOTT STREET
JOHN P. FREESE
MARGORIE B. ROTHSCHILD
315 ABBOTT STREET
NORTH ANDOVER MA 01845
........... -------- ...........
Class 101 Single Family Property Type I Residential
Size Total 0.574 Acres
FY 2024
LIB Mailing Index
Name/Address Type Loan Number Active/Inact. From Until
JOHNRFREESE Owner Adlve
MARGORIE B. ROTHSCHILD
315 ABBOTT STREET
NORTH ANDOVER MA 01845
BOBERIN 11C Previous Customer Inactive l 2/15/2014
9 WHITNEY ROAD
BOXFORD MA 01921
LIB Account Maint.
Account No Cycle Occupant Name Active/Inactive
Bldg Id,25525.0-315 ABBOTT STREET Last Billing Date 6/6/2024
2101296 02 Cycle 02 Active
LIB Services Maint.
Account No.2101296
Service Code Rate Charge Muttlpller/Users
MISCFEE ADMIN FEE 0,63 5/8 7.82 1/1
WTR WATER 01 ALL METER SIZE 10335 1/1
LIB Meter Maintenance
Account No.2101296
Serial No status Location Brand Type Size YTD Cons
45286547 a Active ERT HH b Badger w Water 0.6250625 668
Date Reading Code Consumption Posted Date Variance
5/3/2024 2119 a Actual 25 6113/2024 42%
2/5/2024 2094 a Actual 19 3/14/2024 -41%
11)2/2023 2075 a Actual 31 12/13/2023 -45%
8/312023 2044 a Actual 57 9/1812023 179%
5/3/2023 1987 a Actual 20 6/14/2023 2%
2/2/2023 1967 a Actual 20 3114/2023 -78%
11/2/2022 1947 a Actual 90 12/19/2022 -17%
8/3/2022 1857 a Actual 110 9/20/'2022 309%
5/3/2022 1747 a Actual 26 612112022 9%
2/3/2022 1721 a Actual 25 3/15/2022 -69%
11/2/2021 1696 a Actual 76 12113/2021 -31%
8,(5/2021 1620 a Actual 112 9121/2021 315%
5/6/2021 1508 a ACtUat 27 611512021 -8%
2/4[2021 1481 a Actual 30 3116/2021 -63%
11/3/2020 1451 a Actual 78 12/1612020 -36%
8/5/2020 1373 a Actual 124 91912020 300%
5/6/2020 1249 a Actual 31 6/1012020 21%
2/5/2020 1218 a Actual 26 3/16/2020 -71 0,,v
11/5/2019 1192 a Actual 93 12/23/2019 13%
812/2019 1099 a Actual '79 9126/2019 243%
5/3/2019 1020 a Actual 22 6113/2019 -20%
2/512019 998 a Actual 29 3119/2019 -41%
11/5/2018 969 aActual 50 12112/2018 -67%
813/2018 919 a Actuai 151 9120/2018 57%
5/2/2018 768 a Actual 89 6120/2018 31%
215/2018 679 a Actual 74 3/28/2018 -32%